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Title: Early net ultrafiltration rate and mortality in critically ill patients receiving continuous renal replacement therapy.
Austin Authors: Naorungroj, Thummaporn ;Neto, Ary Serpa;Zwakman-Hessels, Lara;Yanase, Fumitaka ;Eastwood, Glenn M ;Murugan, Raghavan;Kellum, John A;Bellomo, Rinaldo 
Affiliation: School and Public Health and Preventive Medicine, Monash University, Australian and New Zealand Intensive Care Research Centre, Melbourne, Victoria, Australia
Department of Intensive Care, Amsterdam University Medical Center, Amsterdam, The Netherlands
Department of Intensive Care, Faculty of Medicine, Siriraj Hospital, Mahidol University, Bangkok, Thailand
Department of Intensive Care, Austin Health, Heidelberg, Victoria, Australia
Centre for Integrated Critical Care, University of Melbourne, Melbourne, Victoria, Australia
Data Analytics Research and Evaluation (DARE) Centre, Austin Health and The University of Melbourne, Heidelberg, Victoria, Australia
Department of Critical Care Medicine, Clinical Research, Investigation, and Systems Modeling of Acute Illness Center, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
Center for Critical Care Nephrology, Department of Critical Care Medicine, University of Pittsburgh, Pittsburgh, PA, USA
Department of Critical Care, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
Department of Critical Care Medicine, Hospital Israelita Albert Einstein, São Paulo, Brazil
Issue Date: 7-Apr-2020 2020-04-07
Publication information: Nephrology, dialysis, transplantation : official publication of the European Dialysis and Transplant Association - European Renal Association 2020; online first: 7 April
Abstract: In patients treated with continuous renal replacement therapy (CRRT), early net ultrafiltration (NUF) rates may be associated with differential outcomes. We tested whether higher early NUF rates are associated with increased mortality in CRRT patients. We performed a retrospective, observational study of all patients treated with CRRT within 14 days of intensive care unit admission. We defined the early (first 48 h) NUF rate as the volume of fluid removed per hour adjusted for patient body weight and analysed as a categorical variable (>1.75, 1.01-1.75 and <1.01 mL/kg/h). The primary outcome was 28-day mortality. To deal with competing risk, we also compared different time epochs. We studied 347 patients {median age 64 [interquartile range (IQR) 53-71] years and Acute Physiology and Chronic Health Evaluation III score 73 [IQR 54-90]}. Compared with NUF rates <1.01 mL/kg/h, NUF rates >1.75 mL/kg/h were associated with greater mortality rates in each epoch: Days 0-5, adjusted hazard ratio (aHR) 1.27 [95% confidence interval (CI) 1.21-1.33]; Days 6-10, aHR 1.62 (95% CI 1.55-1.68); Days 11-15, aHR 1.87 (95% CI 1.79-1.94); Days 16-26, aHR 1.92 (95% CI 1.84-2.01) and Days 27-28, aHR 4.18 (95% CI 3.98-4.40). For every 0.5 mL/kg/h NUF rate increase, mortality similarly increased during these epochs. Compared with early NUF rates <1.01 mL/kg/h, NUF rates >1.75 mL/kg/h are associated with increased mortality. These observations provide the rationale for clinical trials to confirm or refute these findings.
DOI: 10.1093/ndt/gfaa032
ORCID: 0000-0002-1650-8939
PubMed URL: 32259841
Type: Journal Article
Subjects: CRRT
continuous renal replacement therapy
net ultrafiltration
Appears in Collections:Journal articles

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